Physical capacity outcomes in patients with severe obesity after 12 months of physician‐led multidisciplinary team care: A case series from a public hospital clinical obesity service

Abstract

Summary Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician‐led multidisciplinary care from a “real world” Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre‐test/post‐test (mean ± SD) improvements in the 6‐minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30‐second sit‐to‐stand test (11 ± 4 to 15 ± 6 counts) and sit‐and‐reach test (−12 ± 13 to −8 ± 15 cm). Using linear mixed‐effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12‐month time period (56 m), body mass index (BMI, −3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit‐to‐stand was associated with 12‐month time period (3 counts), age at referral (−0.2 counts), BMI (−0.2 counts), and diabetes (3 counts); and mean sit‐and‐reach was associated with 12‐month time period (5 cm), female gender (5 cm) and total medications (−0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.

Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss

“…All patients enrolled were over 18 years of age with a BMI ≥40 kg/m 2 and at least one weight-related medical comorbidity, the most common being T2DM or nonalcoholic fatty liver disease (NAFLD). The components of the metabolic clinic have been previously described in detail by Atlantis et al [26]. In brief, the program offers a multidisciplinary approach involving endocrinologists, a gastroenterologist, dietitian, a psychiatrist, psychologists, physiotherapists and a specialist nurse.…”

“…Patients with T2DM who performed at least moderate levels of physical activity have been shown to have reduced all-cause mortality compared to those who performed no or mild levels of physical activity [24,25]. Physical capacity outcomes have been shown to improve in patients with class 3 obesity enrolled in our multidisciplinary program that included supervised exercise [26]. However, patients with class 3 obesity appear to face more barriers to physical exercise than patients without class 3 obesity, and patients may decline participation in supervised exercise programs [27].…”

Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight‐related health problems in clinical and community settings: A rapid review of observational studies

“…Disability is worse for those admitted to hospital with high EOSS than outpatients 39 and thus should be the target of early hospital interventions that focus on rehabilitation and return to function. Specialized clinical obesity services with supervised onsite exercise have been shown to be effective for improving physical capacity and function in patients with severe obesity 48 …”

Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity

“…All patients were seen by a physician, dietitian and psychologist. The weight management program has been described in detail previously [ 28 , 29 , 30 , 31 ]. Dietary advice was personalised, which included but was not limited to advice for a 500 Kcal reduced diet, partial meal replacement and/or a low-calorie diet.…”